NPI | 1669119145 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12444) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2022-05-17 |
Last Update Date | 2023-06-16 |