| NPI | 1205287174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NH 1287) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 019735) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2018-03-17 |