| NPI | 1588811442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 000569) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 000569-1) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2019-01-03 |