| NPI | 1396809661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 013975-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA AP2200) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2010-10-14 |