NPI | 1598042764 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA155662) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2011-11-15 |
Last Update Date | 2018-02-08 |