NPI | 1811474216 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: 1153399) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-14116) |
Enumeration Date | 2018-07-27 |
Last Update Date | 2024-09-06 |