| NPI | 1952540072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 23 P68901) |
| Enumeration Date | 2009-02-12 |
| Last Update Date | 2020-12-01 |