NPI | 1689234700 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA065790) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA005984) |
Enumeration Date | 2019-06-20 |
Last Update Date | 2024-09-13 |