| NPI | 1861984239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 023962) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA19417) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2025-09-09 |