NPI | 1770885212 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AL PA-735) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AL PA735) |
Enumeration Date | 2010-12-02 |
Last Update Date | 2024-10-01 |