| NPI | 1669434635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AHALAM DHALI Credentialing Specialist 716-630-1219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 180616) |
| 207R00000X Internal Medicine (Licence: NY 200751) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2018-08-23 |