NPI | 1124285184 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C04452) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 01342) |
Enumeration Date | 2008-05-19 |
Last Update Date | 2024-05-21 |