NPI | 1144254418 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 10-95) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015190) |
363A00000X Physician Assistant (Licence: OH 50003018) | |
Enumeration Date | 2006-07-10 |
Last Update Date | 2017-02-10 |