NPI | 1699738229 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8338) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA00739) |
Enumeration Date | 2006-04-06 |
Last Update Date | 2022-12-30 |