NPI | 1669825295 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OK 845) |
Enumeration Date | 2016-07-19 |
Last Update Date | 2022-04-18 |