NPI | 1093050098 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: DE C5-0000852) |
Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: DE C5-0000852) |
Enumeration Date | 2012-12-01 |
Last Update Date | 2012-12-01 |