NPI | 1124064183 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3813) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MT 232) |
Enumeration Date | 2006-06-20 |
Last Update Date | 2019-10-15 |