| NPI | 1285730481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 001682) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 1682) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2023-07-03 |