NPI | 1669898086 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110006620) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD 635) |
363A00000X Physician Assistant (Licence: DC PA200001939) | |
363A00000X Physician Assistant (Licence: MD C0008416) | |
Enumeration Date | 2014-03-10 |
Last Update Date | 2024-07-22 |