| NPI | 1851556013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 012642) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 12642) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2008-07-26 |
| Last Update Date | 2023-07-06 |