NPI | 1629220488 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-2733) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT MT 543) |
Enumeration Date | 2008-10-10 |
Last Update Date | 2024-07-18 |