NPI | 1689751893 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 5924) |
Additional Taxonomies | 183500000X Pharmacist (Licence: AL 15395) |
Enumeration Date | 2006-11-01 |
Last Update Date | 2015-09-22 |