| NPI | 1811341100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BORIS KHAIMOV Managing Member 718-431-5251 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00236800) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2016-04-22 |