| NPI | 1477883635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 013768) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 13768) |
| Enumeration Date | 2010-01-10 |
| Last Update Date | 2023-07-06 |