NPI | 1427726413 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009335) |
Additional Taxonomies | 208000000X Pediatrics (Licence: MI 5601010740) |
Enumeration Date | 2021-09-02 |
Last Update Date | 2025-07-23 |