NPI | 1356457360 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 1063) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 96) |
Enumeration Date | 2006-08-22 |
Last Update Date | 2013-07-08 |