NPI | 1235443193 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1255) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 002097) |
Enumeration Date | 2010-08-03 |
Last Update Date | 2017-03-17 |