NPI | 1649823782 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13888) |
Additional Taxonomies | 2251C2600X Physical Therapist, Cardiopulmonary (Licence: NC 18418) |
Enumeration Date | 2019-07-18 |
Last Update Date | 2024-09-10 |