| NPI | 1053971440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 023583) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 23583) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2023-07-17 |