NPI | 1164411989 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AK PAD A 1056) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK PAD A 1056) |
Enumeration Date | 2005-10-14 |
Last Update Date | 2016-09-13 |