| NPI | 1326009812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA001613L) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 010472-1) |
| Enumeration Date | 2006-04-01 |
| Last Update Date | 2012-03-13 |