| NPI | 1811473796 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 022243) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 22243) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2024-12-16 |