NPI | 1376196154 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY 23694) |
Enumeration Date | 2019-07-19 |
Last Update Date | 2023-06-30 |