NPI | 1659322279 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C50000481) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA052140) |
Enumeration Date | 2006-05-16 |
Last Update Date | 2008-05-29 |