NPI | 1174720866 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110007249) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2160-023) |
Enumeration Date | 2007-06-27 |
Last Update Date | 2023-12-20 |