NPI | 1508951690 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0004627) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0002451) |
363A00000X Physician Assistant (Licence: PA MA0532470) | |
Enumeration Date | 2006-10-04 |
Last Update Date | 2016-03-28 |