| NPI | 1427225168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NY 009882) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MD C04936) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2022-07-21 |