| NPI | 1568488633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 23-004244) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 4244) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2023-07-03 |