| NPI | 1427442680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: TN 3599) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 018514) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2022-03-31 |