NPI | 1255729919 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MA PAT0068) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: ME PA1905) |
Enumeration Date | 2015-01-05 |
Last Update Date | 2023-03-07 |