| NPI | 1881758217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 007252) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 0072521) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2016-09-23 |