NPI | 1295887032 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NY 001947-1) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 001947) |
Enumeration Date | 2007-01-18 |
Last Update Date | 2007-07-08 |