NPI | 1639144843 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA 32) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA PA32) |
Enumeration Date | 2006-02-21 |
Last Update Date | 2021-11-15 |