| NPI | 1598731135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY MB0511217) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 006425-1) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2023-01-18 |