| NPI | 1174249049 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 029090) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 029090) |
| Enumeration Date | 2022-10-12 |
| Last Update Date | 2025-01-27 |