NPI | 1184127797 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1803) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2018-03-10 |
Last Update Date | 2025-03-19 |