| NPI | 1922128917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 010320) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 010320) |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2020-11-05 |