| NPI | 1609944636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA441) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL pa9102343) |
| 363A00000X Physician Assistant (Licence: NY 007122-1) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2024-06-06 |