NPI | 1508376658 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1550) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA185251) |
Enumeration Date | 2017-10-03 |
Last Update Date | 2021-09-08 |