NPI | 1831594134 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5181) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA PA5181) |
363A00000X Physician Assistant (Licence: RI #PA 00788) | |
Enumeration Date | 2014-10-29 |
Last Update Date | 2021-10-15 |