| NPI | 1659826170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 020261-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 20261) |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2023-06-29 |