| NPI | 1104222793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 023917) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: DC PA031095) |
| 363A00000X Physician Assistant (Licence: DC PA031095) | |
| 363A00000X Physician Assistant (Licence: NY 23917) | |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2023-07-03 |