NPI | 1114474970 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1834) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA55487) |
363A00000X Physician Assistant (Licence: IN 10002114A) | |
Enumeration Date | 2016-09-08 |
Last Update Date | 2023-09-18 |