NPI | 1528773397 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 029570) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2023-01-17 |
Last Update Date | 2024-04-08 |