NPI | 1861726259 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1351) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105223) |
Enumeration Date | 2009-10-01 |
Last Update Date | 2022-11-17 |