NPI | 1598737074 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 4373) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: 1030983) |
Enumeration Date | 2006-02-07 |
Last Update Date | 2014-08-06 |