| NPI | 1245319730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 016070) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR P-T0616) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2012-10-03 |