NPI | 1265995658 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA10012) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2019-04-11 |
Last Update Date | 2023-01-24 |