NPI | 1699166850 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 261QM1102X Clinic/Center, Military Outpatient Operational (Transportable) Component |
Enumeration Date | 2015-02-10 |
Last Update Date | 2024-02-08 |