NPI | 1831126788 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2002024940) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 1501284) |
Enumeration Date | 2006-06-27 |
Last Update Date | 2021-08-12 |