NPI | 1760994016 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6349) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA PA6349) |
Enumeration Date | 2017-10-26 |
Last Update Date | 2024-06-25 |