NPI | 1922087808 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NY 007897) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 007897) |
208100000X Physical Medicine & Rehabilitation (Licence: NY 007897) | |
Enumeration Date | 2006-01-10 |
Last Update Date | 2023-01-16 |