NPI | 1013744051 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9119590) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0009619) |
Enumeration Date | 2024-09-16 |
Last Update Date | 2025-02-14 |