NPI | 1184766776 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 11864) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601004724) |
Enumeration Date | 2007-02-12 |
Last Update Date | 2025-09-29 |