NPI | 1043998289 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: 1213210) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2023-07-07 |
Last Update Date | 2023-10-27 |