NPI | 1164567376 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 011726) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 011726) |
Enumeration Date | 2007-02-21 |
Last Update Date | 2022-02-06 |