NPI | 1285664151 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3434) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 3434) |
Enumeration Date | 2006-07-04 |
Last Update Date | 2021-10-14 |