NPI | 1083769111 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA AP2303) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NH 0661) |
Enumeration Date | 2007-01-25 |
Last Update Date | 2022-11-14 |