NPI | 1942090360 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 7132) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2025-05-08 |
Last Update Date | 2025-07-10 |