NPI | 1710319553 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA030795) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MD C0005138) |
363A00000X Physician Assistant (Licence: MD C0005138) | |
363AM0700X Physician Assistant, Medical (Licence: MD C0005138) | |
Enumeration Date | 2013-08-03 |
Last Update Date | 2024-10-25 |