| NPI | 1396346276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 025929) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 25929) |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2023-07-03 |