NPI | 1902481641 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA005637) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA061776) |
Enumeration Date | 2021-03-15 |
Last Update Date | 2021-05-25 |