| NPI | 1124436779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 017621) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 17621) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2023-06-29 |