NPI | 1639121312 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 592) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 592) |
Enumeration Date | 2006-05-17 |
Last Update Date | 2018-03-17 |