NPI | 1124136304 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0003514) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002440) |
Enumeration Date | 2006-08-28 |
Last Update Date | 2011-05-27 |