| NPI | 1255880126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 025437) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 3698) |
| 363A00000X Physician Assistant (Licence: DC PA031430) | |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2020-11-03 |