NPI | 1578019014 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0007780) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2016-08-25 |
Last Update Date | 2024-08-03 |