NPI | 1245774397 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 6741) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 10126252-1206) |
Enumeration Date | 2016-12-08 |
Last Update Date | 2018-03-17 |