NPI | 1124144043 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 786) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-01817) |
Enumeration Date | 2007-03-22 |
Last Update Date | 2009-10-09 |