NPI | 1619940921 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 005845) |
Additional Taxonomies | 225500000X Specialist/Technologist |
Enumeration Date | 2006-02-08 |
Last Update Date | 2018-12-28 |