NPI | 1275953614 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-07910) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 017481-1) |
Enumeration Date | 2014-04-24 |
Last Update Date | 2021-03-15 |