| NPI | 1497422141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI 1185908) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 028646) |
| Enumeration Date | 2021-08-29 |
| Last Update Date | 2025-09-26 |