NPI | 1871669796 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0011713) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0002049) |
Enumeration Date | 2006-11-24 |
Last Update Date | 2025-02-26 |