| NPI | 1699446187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: 027526) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 27526) |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2023-07-17 |