| NPI | 1992019962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 014921) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002424) |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2023-08-31 |