NPI | 1053040691 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 028648) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 28648) |
Enumeration Date | 2022-06-08 |
Last Update Date | 2023-07-17 |