| NPI | 1801041991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 012991) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 51722) |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2021-03-29 |