| NPI | 1659509628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 013344-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002281) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2016-03-22 |