NPI | 1457463135 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003235) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 01046) |
363AM0700X Physician Assistant, Medical (Licence: WV 01046) | |
363AS0400X Physician Assistant, Surgical (Licence: WV 01046) | |
Enumeration Date | 2006-08-31 |
Last Update Date | 2018-12-28 |