| NPI | 1245681865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NY 003555) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 003555 1) |
| 363AM0700X Physician Assistant Medical (Licence: NY 003555 1) | |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2016-06-24 |