| NPI | 1699037945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 019047) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA056083) |
| 363AM0700X Physician Assistant, Medical (Licence: PA OA003028) | |
| 363AS0400X Physician Assistant, Surgical (Licence: OH 50.003694) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2018-04-25 |