| NPI | 1699793901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA054858) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 007964-1) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2011-04-18 |