NPI | 1700052297 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-07061) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011977) |
Enumeration Date | 2008-05-05 |
Last Update Date | 2020-10-26 |