| NPI | 1609511427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 030974) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9115015) |
| Enumeration Date | 2022-05-05 |
| Last Update Date | 2024-01-05 |