| NPI | 1174701007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 011748) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NY 320446) |
| 363A00000X Physician Assistant (Licence: CT 002803) | |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2018-03-17 |