| NPI | 1033465133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 015563-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015563-1) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 15563) | |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2023-07-07 |