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 |