| NPI | 1669434536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 004068) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 0040681) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2019-02-26 |