| NPI | 1225053218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 005139-1) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 102358) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2012-06-06 |