NPI | 1861680704 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2020019036) |
Enumeration Date | 2007-10-04 |
Last Update Date | 2025-05-29 |