| NPI | 1164623633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 015149) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 15149) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2023-07-06 |