NPI | 1699886614 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 010867) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: 10867) |
Enumeration Date | 2006-08-31 |
Last Update Date | 2014-07-09 |