NPI | 1801506183 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2022046412) |
Additional Taxonomies | 363A00000X Physician Assistant |
363A00000X Physician Assistant (Licence: MO pending) | |
Enumeration Date | 2022-11-28 |
Last Update Date | 2022-12-30 |