| NPI | 1710949433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 009011) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 009011) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2022-02-22 |