NPI | 1366496804 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME EC201008) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 011016-1) |
Enumeration Date | 2006-05-20 |
Last Update Date | 2021-03-11 |