NPI | 1780087502 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-1187) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA173732) |
Enumeration Date | 2014-10-07 |
Last Update Date | 2024-09-09 |