NPI | 1831554336 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 1710I1002X Military Health Care Provider Independent Duty Corpsman |
Enumeration Date | 2015-12-28 |
Last Update Date | 2024-02-21 |