NPI | 1609822543 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 275-23) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 275-023) |
Enumeration Date | 2006-05-25 |
Last Update Date | 2020-12-15 |