NPI | 1588226039 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA060817) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA060817) |
Enumeration Date | 2019-07-05 |
Last Update Date | 2024-09-30 |