NPI | 1588830194 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE c5-0005942) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA ma050950) |
Enumeration Date | 2008-05-03 |
Last Update Date | 2019-01-28 |