| NPI | 1235392663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY P65457) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9118121) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2023-10-19 |