NPI | 1063101129 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 12740) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 12740) |
Enumeration Date | 2023-05-04 |
Last Update Date | 2024-11-20 |