NPI | 1619396223 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2983) |
Additional Taxonomies | 183500000X Pharmacist (Licence: SC 12619) |
Enumeration Date | 2014-04-10 |
Last Update Date | 2022-03-24 |