NPI | 1194119313 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: AK 114033) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical |
Enumeration Date | 2015-03-25 |
Last Update Date | 2023-11-13 |