NPI | 1770983298 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 018017) |
Additional Taxonomies | 363A00000X Physician Assistant |
363A00000X Physician Assistant (Licence: NY 18017) | |
Enumeration Date | 2014-09-03 |
Last Update Date | 2023-05-15 |