NPI | 1285143933 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5787) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA 60792494) |
Enumeration Date | 2017-09-26 |
Last Update Date | 2024-07-03 |