NPI | 1518914290 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110002807) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA156566) |
363A00000X Physician Assistant (Licence: NH 0479) | |
363A00000X Physician Assistant (Licence: WA PA60485011) | |
Enumeration Date | 2006-05-28 |
Last Update Date | 2023-12-15 |