NPI | 1538883855 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA063867) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0011801) |
363A00000X Physician Assistant (Licence: PA OA006212) | |
Enumeration Date | 2022-09-29 |
Last Update Date | 2022-11-01 |