NPI | 1629386222 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MD C0004325) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0004325) |
Enumeration Date | 2010-09-16 |
Last Update Date | 2019-04-01 |