| NPI | 1376913731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 23 019235) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY P99582) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2018-07-18 |