| NPI | 1760509574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 008978) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NY 08978) |
| Enumeration Date | 2007-03-25 |
| Last Update Date | 2022-12-07 |