| NPI | 1437196169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 006164) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 52582) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2023-01-04 |