| NPI | 1528205564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 012928) |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2011-10-31 |