| NPI | 1245235761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 23-013281) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: RI PA00256) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2023-03-07 |