| NPI | 1467556811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 005879) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 5879) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 005879) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2023-07-05 |