NPI | 1295926681 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 0550031115) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM pa20090038) |
Enumeration Date | 2007-08-09 |
Last Update Date | 2012-03-12 |