| NPI | 1588316665 |
|---|---|
| Former Name | NICHOLAS PETERS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA210255) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601010960) |
| Enumeration Date | 2022-01-20 |
| Last Update Date | 2023-04-25 |