NPI | 1629176615 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 200564) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL 1069238) |
Enumeration Date | 2006-09-21 |
Last Update Date | 2013-04-09 |