NPI | 1831393362 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003112) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601003112) |
Enumeration Date | 2007-06-11 |
Last Update Date | 2010-06-01 |