NPI | 1023508751 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA213270) |
Additional Taxonomies | 106S00000X Behavior Technician |
Enumeration Date | 2018-05-17 |
Last Update Date | 2023-12-07 |