NPI | 1336925585 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA200001841) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C09181) |
Enumeration Date | 2023-09-05 |
Last Update Date | 2024-09-25 |