NPI | 1902283401 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 024623) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2015-05-04 |
Last Update Date | 2022-02-15 |