NPI | 1285296137 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: 1285296137) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: 1285296137) |
Enumeration Date | 2019-07-01 |
Last Update Date | 2024-09-11 |