NPI | 1629086962 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ME 001186) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 001431) |
Enumeration Date | 2006-08-03 |
Last Update Date | 2009-10-08 |