| NPI | 1346643806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 021761) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0005511) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 3832) | |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2022-07-21 |