| NPI | 1992998330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 009508) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 009508) |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2025-08-26 |