NPI | 1730691429 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1753) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA11564) |
Enumeration Date | 2017-11-02 |
Last Update Date | 2021-07-14 |