NPI | 1285968297 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003729) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2009-09-23 |
Last Update Date | 2023-02-27 |