NPI | 1649670522 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2346) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
363A00000X Physician Assistant | |
Enumeration Date | 2014-08-28 |
Last Update Date | 2023-01-24 |