| NPI | 1093102865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICARDO LUIS BAEZ Physician Assistant 347-853-0915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 016861) |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2015-04-20 |