| NPI | 1780042952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 019504) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY P00552) |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2016-02-11 |