NPI | 1629457981 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 7658) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2015-05-20 |
Last Update Date | 2024-11-18 |