NPI | 1124448964 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005595) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA225085) |
Enumeration Date | 2014-04-20 |
Last Update Date | 2025-06-15 |