NPI | 1285763391 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110002350) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA030452) |
Enumeration Date | 2007-03-05 |
Last Update Date | 2021-09-21 |