| NPI | 1770901399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 017377-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 17377) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2023-04-28 |