| NPI | 1467525121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 026962) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 1158) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2022-03-02 |