NPI | 1326278987 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 002448) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA3795) |
Enumeration Date | 2009-07-16 |
Last Update Date | 2018-03-17 |