NPI | 1215905997 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0002419) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA052023) |
Enumeration Date | 2006-03-09 |
Last Update Date | 2008-02-13 |