| NPI | 1649335316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 006142) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 0061421) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 006142) | |
| Enumeration Date | 2006-12-23 |
| Last Update Date | 2023-12-19 |