NPI | 1699332114 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09140) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2019-05-20 |
Last Update Date | 2024-08-07 |