NPI | 1780694000 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1640) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011256) |
Enumeration Date | 2006-08-09 |
Last Update Date | 2020-11-25 |