NPI | 1346120052 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA066852) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0012347) |
Enumeration Date | 2025-09-03 |
Last Update Date | 2025-09-25 |