NPI | 1164151395 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 5659) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 122837) |
Enumeration Date | 2022-06-04 |
Last Update Date | 2025-02-27 |