NPI | 1063867950 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3033) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 3033) |
363AM0700X Physician Assistant, Medical (Licence: TN 3033) | |
Enumeration Date | 2016-04-28 |
Last Update Date | 2021-08-04 |