NPI | 1578291381 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110008909) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-008909) |
Enumeration Date | 2022-08-10 |
Last Update Date | 2024-01-03 |