| NPI | 1699886614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 010867) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: 10867) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-07-09 |