NPI | 1831612191 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110-005856) |
Enumeration Date | 2017-07-19 |
Last Update Date | 2023-06-05 |