NPI | 1679467732 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PR 002557) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL TPPA977) |
Enumeration Date | 2025-06-04 |
Last Update Date | 2025-07-28 |