NPI | 1790959369 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C03648) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA030527) |
Enumeration Date | 2008-04-15 |
Last Update Date | 2023-07-21 |