NPI | 1700419041 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13881) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MS 1170747) |
Enumeration Date | 2020-02-14 |
Last Update Date | 2024-08-21 |