| NPI | 1649281189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 003601-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 3601) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2023-07-05 |