| NPI | 1831529304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 017144) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056609) |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2016-09-19 |