| NPI | 1053040691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 028648) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 28648) |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2023-07-17 |