NPI | 1114035672 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007057) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10003791) |
Enumeration Date | 2006-08-26 |
Last Update Date | 2016-01-28 |