NPI | 1295837102 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 02109) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 4446) |
Enumeration Date | 2006-09-01 |
Last Update Date | 2024-02-05 |