NPI | 1194471334 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 027886) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NY 027886) |
Enumeration Date | 2022-02-25 |
Last Update Date | 2022-03-08 |