| NPI | 1386875649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 013408) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 13408) |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2023-03-21 |