| NPI | 1427236835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 014453) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 3520) |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2019-10-17 |