| NPI | 1538619051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 020244-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 20244) |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2023-06-29 |