NPI | 1528630308 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C07993) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C07993) |
Enumeration Date | 2021-07-12 |
Last Update Date | 2021-11-30 |