| NPI | 1023149416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 011716) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9104950) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2019-02-22 |