NPI | 1841674405 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT MED-PAC-Lic-59289) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-1264) |
Enumeration Date | 2015-07-14 |
Last Update Date | 2018-03-17 |