| NPI | 1699339549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY P100032) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY P100032) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2020-02-25 |