| NPI | 1841583523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 000091) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 000091) |
| Enumeration Date | 2011-05-27 |
| Last Update Date | 2011-05-27 |