| NPI | 1821507799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 021353) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NY 021353) |
| Enumeration Date | 2017-09-23 |
| Last Update Date | 2022-09-16 |