| NPI | 1134783749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 031828) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 5144) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2025-07-17 |