| NPI | 1629597976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 21476) |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2023-06-29 |