| NPI | 1144921743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 029759) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: NY 029759) |
| Enumeration Date | 2023-03-13 |
| Last Update Date | 2023-05-08 |