| NPI | 1699853838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 004074) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 0040741) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2007-12-07 |