NPI | 1275149239 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: SC MPA3687PA) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC MPA3687PA) |
Enumeration Date | 2020-09-16 |
Last Update Date | 2024-10-11 |