NPI | 1366603797 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003713) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-01389) |
Enumeration Date | 2008-06-18 |
Last Update Date | 2015-07-06 |