NPI | 1770056566 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NV PA2082) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 025290) |
Enumeration Date | 2019-01-04 |
Last Update Date | 2024-06-18 |