NPI | 1003206434 |
---|---|
Other Name | EJ OCCHIBOI |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08548) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 000907) |
363AS0400X Physician Assistant, Surgical (Licence: CT 23.004688) | |
Enumeration Date | 2015-01-22 |
Last Update Date | 2025-01-06 |