| NPI | 1427464486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 018307) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056945) |
| 363A00000X Physician Assistant (Licence: PA OA003325) | |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2019-10-29 |