NPI | 1477101152 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-1260) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-09615) |
Enumeration Date | 2019-08-27 |
Last Update Date | 2024-04-10 |