| NPI | 1740266139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 008447) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NC 0001-04166) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2009-07-09 |