NPI | 1184932493 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003891) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WV 01515) |
Enumeration Date | 2010-09-21 |
Last Update Date | 2021-12-27 |