NPI | 1447548813 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NY 014847) |
Enumeration Date | 2011-07-19 |
Last Update Date | 2023-03-07 |