NPI | 1851462154 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06109) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 281) |
Enumeration Date | 2006-11-10 |
Last Update Date | 2016-04-01 |