NPI | 1770621229 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 004106) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2007-02-04 |
Last Update Date | 2013-04-30 |