NPI | 1184162810 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NC 10248) |
Enumeration Date | 2017-02-01 |
Last Update Date | 2024-05-06 |