| NPI | 1518363415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1119) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 0781884-1) |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2023-11-13 |