NPI | 1225339518 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-02558) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110003375) |
Enumeration Date | 2010-11-03 |
Last Update Date | 2017-03-13 |