NPI | 1285986612 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1004) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ID PA-1004) |
Enumeration Date | 2012-10-09 |
Last Update Date | 2023-07-11 |