NPI | 1902520968 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PR 1444-P.A.) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PR 1444) |
Enumeration Date | 2022-10-03 |
Last Update Date | 2023-03-27 |