NPI | 1134541246 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056441) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003139) |
Enumeration Date | 2014-01-08 |
Last Update Date | 2020-10-12 |