NPI | 1598030371 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK PADA1184) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2012-03-13 |
Last Update Date | 2020-11-05 |