| NPI | 1437547635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 018282) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 0182821) |
| Enumeration Date | 2014-12-23 |
| Last Update Date | 2022-09-15 |