NPI | 1194073387 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA055674) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA 165543) |
363A00000X Physician Assistant (Licence: OR PA165543) | |
Enumeration Date | 2012-08-21 |
Last Update Date | 2023-03-20 |