| NPI | 1831732577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 032611-01) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 58114) |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2025-04-14 |