NPI | 1245563485 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: NY 006730-1) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 006730-1) |
Enumeration Date | 2009-09-04 |
Last Update Date | 2009-09-21 |