NPI | 1306099155 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5356) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA053715) |
Enumeration Date | 2008-10-24 |
Last Update Date | 2019-08-23 |