NPI | 1447806625 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115799) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 023851) |
Enumeration Date | 2019-08-14 |
Last Update Date | 2022-08-25 |