NPI | 1124595889 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 022781) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 5109) |
Enumeration Date | 2018-10-30 |
Last Update Date | 2021-06-04 |