| NPI | 1295031599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 007907) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 0049907) |
| Enumeration Date | 2011-02-03 |
| Last Update Date | 2024-08-23 |