| NPI | 1831268101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 006715) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 006715-1) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2025-07-17 |