NPI | 1639796790 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5552-023) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2020-07-06 |
Last Update Date | 2021-12-01 |