NPI | 1740320092 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 017907) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA000913) |
363AM0700X Physician Assistant, Medical (Licence: CT 003346) | |
Enumeration Date | 2007-02-07 |
Last Update Date | 2022-11-15 |