NPI | 1548566847 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 014585) |
Enumeration Date | 2011-02-03 |
Last Update Date | 2021-12-06 |