| NPI | 1801921127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA 9107139) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 001409) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2017-04-11 |