| NPI | 1699024877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA 9108080) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 001645-1) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 005811) | |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2023-01-03 |