NPI | 1942823083 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110007451) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2020-05-23 |
Last Update Date | 2021-03-12 |