| NPI | 1053821215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009129) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 021402) |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2025-09-30 |