NPI | 1427740075 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OK 5020) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC 5562) |
Enumeration Date | 2023-05-23 |
Last Update Date | 2025-05-07 |