| NPI | 1528628781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 023655) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 23655) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2023-07-03 |