| NPI | 1447650163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 017637-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA2739) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2024-10-15 |