| NPI | 1043663099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 019865) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 19865) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2023-06-29 |