| NPI | 1235205709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 011965) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY P46654) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-08-29 |