NPI | 1023698255 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 026081) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA005309) |
363A00000X Physician Assistant (Licence: PA MA061741) | |
Enumeration Date | 2021-04-12 |
Last Update Date | 2022-03-04 |