| NPI | 1073894531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 014955-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 14955) |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2023-07-06 |