NPI | 1508694852 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 032167) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 032167) |
363AM0700X Physician Assistant, Medical (Licence: NY 032167) | |
Enumeration Date | 2024-07-26 |
Last Update Date | 2024-07-26 |