NPI | 1619137270 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-00146) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-00146) |
Enumeration Date | 2008-06-16 |
Last Update Date | 2021-05-24 |