NPI | 1841739141 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110007161) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-07079) |
Enumeration Date | 2017-02-20 |
Last Update Date | 2022-01-20 |