NPI | 1407620750 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009924) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2023-11-07 |
Last Update Date | 2024-03-18 |