| NPI | 1245463108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 035475) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2026-0033) |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2026-05-28 |