NPI | 1225097710 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1190) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 001823) |
Enumeration Date | 2006-03-22 |
Last Update Date | 2020-12-30 |