| NPI | 1841337201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110007104) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 001678) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2020-06-04 |