NPI | 1528140647 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 110002527) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA882) |
Enumeration Date | 2006-10-19 |
Last Update Date | 2019-02-20 |