NPI | 1457663593 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA PA.200421) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA pending graduation) |
Enumeration Date | 2010-07-06 |
Last Update Date | 2014-02-17 |