| NPI | 1932877347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 027960) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-08-31 |
| Last Update Date | 2022-02-24 |