NPI | 1467928408 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2020030531) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.006912) |
363A00000X Physician Assistant (Licence: IA 126823) | |
Enumeration Date | 2018-10-17 |
Last Update Date | 2024-09-10 |