NPI | 1730422825 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3144-23) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 3144-23) |
Enumeration Date | 2013-03-27 |
Last Update Date | 2023-05-01 |