NPI | 1144576109 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 4383) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601008198) |
Enumeration Date | 2012-07-27 |
Last Update Date | 2025-08-05 |