NPI | 1790169993 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1112) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA5426) |
Enumeration Date | 2015-07-17 |
Last Update Date | 2023-09-20 |