NPI | 1629597976 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 21476) |
Enumeration Date | 2017-09-18 |
Last Update Date | 2023-06-29 |