NPI | 1326144577 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1021) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 17465) |
363A00000X Physician Assistant (Licence: AZ 3024) | |
363A00000X Physician Assistant (Licence: CO 0003911) | |
363A00000X Physician Assistant (Licence: MI 5601004343) | |
Enumeration Date | 2006-09-15 |
Last Update Date | 2017-04-04 |