| NPI | 1700427275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 024015) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 024015) |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2024-09-18 |