NPI | 1215172697 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005363) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-01591) |
Enumeration Date | 2008-12-12 |
Last Update Date | 2017-04-25 |