| NPI | 1699158014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 018728) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA10561) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2024-03-19 |