| NPI | 1972168748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 023606) |
| Additional Taxonomies | 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: NY 023606) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2019-10-15 |