NPI | 1003171851 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54486) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 1301) |
363A00000X Physician Assistant (Licence: FL 9108537) | |
363A00000X Physician Assistant (Licence: IA 002305) | |
363A00000X Physician Assistant (Licence: CO 0004506) | |
Enumeration Date | 2012-07-09 |
Last Update Date | 2021-03-31 |