| NPI | 1437213857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 5104) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 009056) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2022-09-12 |