NPI | 1427232792 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3792) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1368) |
Enumeration Date | 2007-12-21 |
Last Update Date | 2018-07-07 |