| NPI | 1982899886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 012045) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 12045) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2023-04-28 |