NPI | 1871119438 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115808) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 025073) |
363A00000X Physician Assistant (Licence: NY 25073) | |
Enumeration Date | 2020-06-19 |
Last Update Date | 2023-07-03 |