NPI | 1386183994 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 5566) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 020599) |
Enumeration Date | 2017-02-15 |
Last Update Date | 2025-06-26 |