NPI | 1447929484 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 5567) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 556723) |
Enumeration Date | 2021-09-13 |
Last Update Date | 2021-11-02 |