NPI | 1750384343 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 101788) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 101788) |
Enumeration Date | 2005-05-27 |
Last Update Date | 2020-10-25 |