| NPI | 1144430554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 9846-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 19557) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2008-01-29 |