| NPI | 1588142202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 032470-01) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: NY NY000410443E) |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2024-10-21 |