NPI | 1740232966 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-00323) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 1000323) |
Enumeration Date | 2006-05-16 |
Last Update Date | 2022-02-01 |