| NPI | 1457972853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 031757) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA13673) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2024-10-16 |