NPI | 1346958501 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: 1221008) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2022-11-07 |
Last Update Date | 2024-08-01 |