| NPI | 1710953435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 009046-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 009046-1) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2007-10-29 |