NPI | 1477598464 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: DC PA30142) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001150) |
Enumeration Date | 2006-06-17 |
Last Update Date | 2020-11-02 |