NPI | 1073277166 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 5562) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2021-10-26 |
Last Update Date | 2022-05-04 |