| NPI | 1659597870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 015765-1) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: DE C5-0000387) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2015-09-29 |