NPI | 1447286943 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY TL556) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA PA200064) |
Enumeration Date | 2006-06-25 |
Last Update Date | 2018-07-11 |