| NPI | 1487182283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 020831) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 3863) |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2018-02-13 |