| NPI | 1265431878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 006968) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 6968) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2023-07-05 |