NPI | 1487019279 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 019391) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 019391) |
Enumeration Date | 2015-12-21 |
Last Update Date | 2019-01-09 |