NPI | 1043066616 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0012057) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: DE C5-0012057) |
363AM0700X Physician Assistant, Medical (Licence: MD C0009370) | |
363A00000X Physician Assistant (Licence: MD C0009370) | |
Enumeration Date | 2024-04-25 |
Last Update Date | 2024-09-05 |