NPI | 1417119736 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 01351) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 1351) |
Enumeration Date | 2008-06-27 |
Last Update Date | 2025-01-28 |