NPI | 1184615239 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 100436) |
Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NC 100436) |
Enumeration Date | 2005-10-28 |
Last Update Date | 2016-07-12 |