| NPI | 1679798755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 003606) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 3606) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2023-03-21 |