NPI | 1245604768 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 6128) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: AZ 6128) |
Enumeration Date | 2015-11-20 |
Last Update Date | 2024-01-04 |