| NPI | 1033634431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0008983) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 020851) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2023-10-24 |