NPI | 1649700378 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 8374) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 2789) |
Enumeration Date | 2017-06-15 |
Last Update Date | 2023-03-15 |