| NPI | 1245820927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 026711) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 26711) |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2023-07-07 |