NPI | 1700985769 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13626) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001154) |
363A00000X Physician Assistant (Licence: DE C5-0001013) | |
Enumeration Date | 2006-09-22 |
Last Update Date | 2024-12-19 |