NPI | 1063847994 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA057501) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
363AM0700X Physician Assistant, Medical (Licence: PA OA003525) | |
Enumeration Date | 2013-09-11 |
Last Update Date | 2019-11-12 |