| NPI | 1245563485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: NY 006730-1) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 006730-1) |
| Enumeration Date | 2009-09-04 |
| Last Update Date | 2009-09-21 |