NPI | 1396714531 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA01367) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ID CS9387) |
Enumeration Date | 2006-03-17 |
Last Update Date | 2016-02-29 |