| NPI | 1023057692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 001673-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA3529) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2013-09-16 |