NPI | 1134107352 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110840579) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9106607) |
Enumeration Date | 2006-01-06 |
Last Update Date | 2019-02-13 |