NPI | 1184952855 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA054209) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003110) |
Enumeration Date | 2009-11-18 |
Last Update Date | 2023-07-24 |