| NPI | 1659559813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 012314) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 012314-1) |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2024-11-08 |