NPI | 1285785782 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID PA-146) |
208000000X Pediatrics (Licence: ID pa146) | |
208D00000X General Practice (Licence: ID PA146) | |
Enumeration Date | 2007-01-13 |
Last Update Date | 2022-03-25 |