NPI | 1518947548 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL 9103913) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AL PA-365) |
363AM0700X Physician Assistant, Medical (Licence: NC 102483) | |
363A00000X Physician Assistant (Licence: MD C0002449) | |
Enumeration Date | 2006-01-17 |
Last Update Date | 2007-11-22 |