NPI | 1245220193 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 103878) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 103878) |
Enumeration Date | 2005-10-24 |
Last Update Date | 2023-05-01 |