| NPI | 1972653285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 007883-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 07883-1) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2017-09-25 |