NPI | 1851602338 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VT 0031117) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 008599) |
Enumeration Date | 2010-06-29 |
Last Update Date | 2012-06-05 |