NPI | 1346829124 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.1872) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2021-04-07 |
Last Update Date | 2023-12-11 |