| NPI | 1013558188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 029357) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: FL PA9112633) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL PA9112633) | |
| 363A00000X Physician Assistant (Licence: FL PA9112633) | |
| 207T00000X Neurological Surgery (Licence: FL Pa9112633) | |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9112633) | |
| Enumeration Date | 2019-09-30 |
| Last Update Date | 2023-01-12 |