| NPI | 1487363198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 029408) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363A00000X Physician Assistant | |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2024-01-17 |