| NPI | 1144275843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 0044681) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA ap772) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2010-02-26 |