| NPI | 1700167616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C06717) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 015066) |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2023-04-21 |