NPI | 1639691256 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008297) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2017-07-14 |
Last Update Date | 2018-03-29 |