| NPI | 1003495045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 026513) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 026513) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2024-12-18 |