NPI | 1255384467 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 005264) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9102450) |
Enumeration Date | 2006-05-18 |
Last Update Date | 2008-05-09 |