| NPI | 1174807119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 015497) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA60573) |
| 363AM0700X Physician Assistant, Medical (Licence: IL 085.008101) | |
| 363AM0700X Physician Assistant, Medical (Licence: MA PA8445) | |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2023-12-18 |