| NPI | 1073595468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NY 008982-1) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 8982) |
| Enumeration Date | 2005-11-19 |
| Last Update Date | 2023-07-03 |