| NPI | 1326418823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 028353) |
| Additional Taxonomies | 247200000X Technician, Other |
| 363A00000X Physician Assistant (Licence: 1178843) | |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2023-09-30 |