| NPI | 1972605848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 007340-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 007340) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2009-01-12 |