NPI | 1215314042 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110005612) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2015-04-30 |
Last Update Date | 2022-08-23 |