NPI | 1801363601 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.1574) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9112683) |
Enumeration Date | 2018-10-30 |
Last Update Date | 2020-03-13 |