NPI | 1154218006 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2025036081) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-03142) |
Enumeration Date | 2025-06-23 |
Last Update Date | 2025-10-04 |