| NPI | 1124411269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 018512) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 18512) |
| Enumeration Date | 2015-03-13 |
| Last Update Date | 2023-05-15 |