| NPI | 1528362894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 8575) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 014541) |
| Enumeration Date | 2010-12-30 |
| Last Update Date | 2024-10-07 |