NPI | 1730496977 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2011-0012) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00611) |
363A00000X Physician Assistant (Licence: FL PAT9105615) | |
Enumeration Date | 2010-09-09 |
Last Update Date | 2016-08-15 |