| NPI | 1275992257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 019450) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C08453) |
| 363A00000X Physician Assistant (Licence: FL PA9117259) | |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2023-07-17 |