NPI | 1689058000 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0011861) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 018810) |
Enumeration Date | 2015-07-15 |
Last Update Date | 2023-06-14 |