NPI | 1578117925 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 4525) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 4525) |
Enumeration Date | 2019-07-24 |
Last Update Date | 2019-10-24 |