| NPI | 1356505267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 000099) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 000099) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2023-12-18 |