NPI | 1982170445 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08392) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2018-10-22 |
Last Update Date | 2023-07-28 |