NPI | 1780054254 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08480) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2015-09-28 |
Last Update Date | 2023-05-31 |