| NPI | 1083262083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NY 024037) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2022-07-15 |