NPI | 1942224993 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 008492) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001590) |
363AS0400X Physician Assistant, Surgical (Licence: NY 008492) | |
Enumeration Date | 2006-07-26 |
Last Update Date | 2010-02-04 |