NPI | 1235715087 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010426) |
Additional Taxonomies | 208000000X Pediatrics (Licence: MI 5601010426) |
Enumeration Date | 2021-03-22 |
Last Update Date | 2022-12-19 |