NPI | 1386668234 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08101) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00194) |
363A00000X Physician Assistant (Licence: SC 2160) | |
Enumeration Date | 2006-07-26 |
Last Update Date | 2024-08-15 |