NPI | 1225257629 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AL PA767) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL 9118146) |
Enumeration Date | 2007-04-24 |
Last Update Date | 2023-12-11 |