NPI | 1154373983 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12474) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 009787-1) |
363AM0700X Physician Assistant, Medical (Licence: IA 001382) | |
Enumeration Date | 2006-05-17 |
Last Update Date | 2022-08-01 |