NPI | 1003066549 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C03884) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD 1080306) |
Enumeration Date | 2008-09-21 |
Last Update Date | 2009-05-15 |