NPI | 1538565270 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1744) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9108385) |
Enumeration Date | 2014-11-07 |
Last Update Date | 2021-07-20 |