NPI | 1508026105 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 012601) |
Enumeration Date | 2008-06-17 |
Last Update Date | 2019-09-18 |