| NPI | 1457310161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 009788-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA003450L) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2011-07-29 |