NPI | 1043595911 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 015383-1) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9119112) |
363AS0400X Physician Assistant, Surgical (Licence: NY 015383-1) | |
Enumeration Date | 2011-10-11 |
Last Update Date | 2024-08-27 |