| NPI | 1780883785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C03063) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 008146) |
| 363A00000X Physician Assistant (Licence: NY 008146) | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2025-05-30 |