NPI | 1487085676 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 024450) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 002702) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AZ 1134) | |
Enumeration Date | 2013-12-12 |
Last Update Date | 2023-01-30 |