NPI | 1568350593 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0010064) |
Enumeration Date | 2025-06-26 |
Last Update Date | 2025-08-06 |