NPI | 1043939945 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9299) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ PENDING) |
Enumeration Date | 2022-08-24 |
Last Update Date | 2022-10-07 |