NPI | 1285996314 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09395) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 0160607) |
Enumeration Date | 2012-06-14 |
Last Update Date | 2020-10-26 |