NPI | 1487199659 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA059376) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0001111) |
Enumeration Date | 2016-12-27 |
Last Update Date | 2018-06-29 |