| NPI | 1003933771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 005650) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 0056501) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2022-09-14 |