NPI | 1740263995 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 582) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC A956) |
Enumeration Date | 2005-11-22 |
Last Update Date | 2019-04-18 |