NPI | 1386314748 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 024027) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 5419) |
Enumeration Date | 2021-09-16 |
Last Update Date | 2022-03-09 |