| NPI | 1215155056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 002269) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 2269) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2023-06-30 |