NPI | 1336138866 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005570) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1066163) |
Enumeration Date | 2005-10-18 |
Last Update Date | 2023-06-05 |