NPI | 1780652503 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AL PA.477) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.477) |
Enumeration Date | 2006-03-09 |
Last Update Date | 2020-03-02 |