NPI | 1336506153 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 2993) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110010568) |
Enumeration Date | 2016-01-25 |
Last Update Date | 2024-12-31 |