NPI | 1023085974 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 006329) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2006-02-28 |
Last Update Date | 2024-02-26 |