NPI | 1255861712 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09681) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2017-06-18 |
Last Update Date | 2021-05-26 |