NPI | 1689937971 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 6014) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC474) |
363A00000X Physician Assistant (Licence: GA 006436) | |
Enumeration Date | 2012-06-21 |
Last Update Date | 2024-05-22 |