NPI | 1386701829 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 000001122) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2007-01-03 |
Last Update Date | 2019-05-01 |