NPI | 1447539564 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 008273) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 014914) |
Enumeration Date | 2011-08-07 |
Last Update Date | 2020-01-23 |