NPI | 1942794839 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA189053) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2018-06-14 |
Last Update Date | 2025-03-10 |