NPI | 1174201859 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009346) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110009346) |
Enumeration Date | 2023-07-11 |
Last Update Date | 2023-08-15 |