| NPI | 1417279035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 028346) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 028346) |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2025-04-15 |