NPI | 1063193084 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA065385) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2023-07-31 |
Last Update Date | 2024-02-12 |