NPI | 1144781576 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006758) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110006768) |
Enumeration Date | 2019-03-28 |
Last Update Date | 2022-06-14 |