NPI | 1588757736 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IA 001392) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 001392) |
Enumeration Date | 2006-10-02 |
Last Update Date | 2021-12-08 |