NPI | 1194382077 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9503) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601009199) |
Enumeration Date | 2019-05-25 |
Last Update Date | 2022-12-15 |