NPI | 1396752119 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA223626) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 3133301206) |
Enumeration Date | 2006-08-02 |
Last Update Date | 2025-03-07 |