NPI | 1841234630 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA002426L) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C50000117) |
Enumeration Date | 2006-06-15 |
Last Update Date | 2022-03-09 |