| NPI | 1811930399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 006606) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 6606) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2023-04-28 |