NPI | 1093225229 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-07622) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 0010-07622) |
Enumeration Date | 2017-10-02 |
Last Update Date | 2017-12-27 |