NPI | 1245081710 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 5332) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2024-04-01 |
Last Update Date | 2024-06-19 |