NPI | 1184811986 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-747) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 2437) |
Enumeration Date | 2007-09-26 |
Last Update Date | 2023-11-25 |