NPI | 1043312572 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 004878) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 004878) |
363A00000X Physician Assistant (Licence: SC PA1183) | |
Enumeration Date | 2006-09-04 |
Last Update Date | 2009-12-23 |