| NPI | 1154345015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 006612) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9114434) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2022-11-16 |