NPI | 1841513157 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-1213) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 1902) |
Enumeration Date | 2010-03-02 |
Last Update Date | 2023-07-27 |