NPI | 1033648753 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AR 273) |
Enumeration Date | 2017-06-06 |
Last Update Date | 2024-07-03 |