NPI | 1770953267 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 023398) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 617742-1) |
163W00000X Registered Nurse (Licence: CA 811691) | |
Enumeration Date | 2015-09-28 |
Last Update Date | 2023-08-17 |