NPI | 1801807334 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5034) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA000767L) |
Enumeration Date | 2006-08-10 |
Last Update Date | 2013-08-20 |