NPI | 1205879137 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9106277) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA279) |
Enumeration Date | 2006-06-14 |
Last Update Date | 2011-11-18 |