| NPI | 1730364373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 029983) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 001839) |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2023-06-08 |