NPI | 1689962581 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MD C004461) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9117365) |
Enumeration Date | 2011-07-13 |
Last Update Date | 2023-05-26 |