NPI | 1427899053 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14485) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2024-06-06 |
Last Update Date | 2024-09-24 |