NPI | 1861606220 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1417) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601004991) |
Enumeration Date | 2007-05-09 |
Last Update Date | 2018-11-30 |