| NPI | 1447769096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 021599) |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2021-05-21 |