NPI | 1396727533 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 001706) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001706) |
Enumeration Date | 2005-11-15 |
Last Update Date | 2021-12-06 |