NPI | 1558747535 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2379) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC MPA.2379PA) |
Enumeration Date | 2015-08-03 |
Last Update Date | 2015-08-03 |