NPI | 1386784262 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 006559) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 4714) |
Enumeration Date | 2007-02-08 |
Last Update Date | 2021-10-18 |