NPI | 1265431878 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 006968) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 6968) |
Enumeration Date | 2005-07-15 |
Last Update Date | 2023-07-05 |