| NPI | 1568631000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 012032-1) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2008-03-01 |