| NPI | 1528410750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 019799) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 19799) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2023-07-17 |