| NPI | 1184711848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 008534) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 008534-1) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2022-06-20 |