NPI | 1386212934 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 027344) |
Additional Taxonomies | 363A00000X Physician Assistant |
363A00000X Physician Assistant | |
Enumeration Date | 2021-06-10 |
Last Update Date | 2024-03-25 |