NPI | 1306957600 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: DE C5-0000222) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA002535L) |
Enumeration Date | 2006-08-31 |
Last Update Date | 2019-01-24 |