NPI | 1083931935 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-03870) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2010-04-30 |
Last Update Date | 2022-12-08 |