NPI | 1861568305 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM 90-PA23) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NM 90PA23) |
Enumeration Date | 2006-11-27 |
Last Update Date | 2018-02-05 |