NPI | 1851983886 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PABP.BG.61267147) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9114002) |
Enumeration Date | 2021-02-10 |
Last Update Date | 2022-04-12 |