| NPI | 1346447513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 031904-01) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001911) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2024-07-02 |