NPI | 1649552225 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003668) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.008112) |
Enumeration Date | 2011-09-09 |
Last Update Date | 2024-11-05 |