| NPI | 1437434057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 3477) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015143) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 015143) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 015143) | |
| Enumeration Date | 2011-10-14 |
| Last Update Date | 2018-07-02 |