| NPI | 1114987625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 009394) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 009394) |
| 208800000X Urology (Licence: NY 009394) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 009394) | |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2016-05-09 |