NPI | 1336921782 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064976) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA064976) |
Enumeration Date | 2023-10-19 |
Last Update Date | 2024-04-26 |