NPI | 1699030999 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003924) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110003924) |
Enumeration Date | 2012-07-12 |
Last Update Date | 2024-06-05 |