| NPI | 1942273610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 015305) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 10032) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2013-11-19 |