NPI | 1285344986 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-1163) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 5312) |
Enumeration Date | 2022-12-05 |
Last Update Date | 2024-10-31 |