NPI | 1528413218 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
Enumeration Date | 2016-04-29 |
Last Update Date | 2024-07-11 |