NPI | 1225689847 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601009505) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601009505) |
Enumeration Date | 2019-09-25 |
Last Update Date | 2021-03-29 |