| NPI | 1467938324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 022326) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 1154654) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2018-08-02 |