NPI | 1235639196 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 7097) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-07865) |
Enumeration Date | 2018-02-17 |
Last Update Date | 2024-09-04 |