| NPI | 1235186222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 008311) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 008311-1) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2023-07-27 |