NPI | 1275390692 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 031527) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 031527) |
Enumeration Date | 2024-03-04 |
Last Update Date | 2024-03-29 |