NPI | 1588900930 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
Enumeration Date | 2012-12-12 |
Last Update Date | 2023-10-20 |