NPI | 1811413859 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009071) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA007242) |
Enumeration Date | 2017-08-22 |
Last Update Date | 2025-06-02 |