| NPI | 1699056416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 015082) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 15082) |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2023-03-21 |