NPI | 1588998371 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08057) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 2667) |
Enumeration Date | 2009-09-25 |
Last Update Date | 2021-06-10 |