| NPI | 1972850436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 015786) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 15786) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2023-06-30 |