| NPI | 1871119438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115808) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 025073) |
| 363A00000X Physician Assistant (Licence: NY 25073) | |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2023-07-03 |