| NPI | 1457308884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 007479) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 007479-1) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2019-10-24 |