NPI | 1538158415 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007837) |
Enumeration Date | 2005-10-14 |
Last Update Date | 2023-08-17 |