NPI | 1629201249 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1177) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10001138A) |
Enumeration Date | 2009-08-30 |
Last Update Date | 2014-08-05 |