| NPI | 1285112144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 022290) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 022290-1) |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2019-12-04 |