NPI | 1548484090 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA 1197) |
Additional Taxonomies | 363A00000X Physician Assistant |
363A00000X Physician Assistant (Licence: RI PA00602) | |
Enumeration Date | 2007-04-13 |
Last Update Date | 2024-09-25 |