NPI | 1871743658 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NE 1963) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KS T-02286) |
Enumeration Date | 2008-09-29 |
Last Update Date | 2022-07-21 |