NPI | 1225781917 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1192223) |
Enumeration Date | 2022-02-02 |
Last Update Date | 2022-02-02 |