NPI | 1861442261 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0003031) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC 030357) |
Enumeration Date | 2006-05-10 |
Last Update Date | 2007-07-08 |