| NPI | 1134438377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 14333) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-03109) |
| Enumeration Date | 2010-10-06 |
| Last Update Date | 2026-04-29 |