| NPI | 1922087808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 007897) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 007897) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 007897) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2023-01-16 |