| NPI | 1144270208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 004653) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA30014) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2021-03-11 |