NPI | 1679345003 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 10138) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2023-10-30 |
Last Update Date | 2024-08-22 |