NPI | 1922525203 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008383) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2017-08-28 |
Last Update Date | 2022-08-19 |