| NPI | 1821032491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY '010126) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 010126) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2022-11-18 |