NPI | 1861672990 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MS PA00206) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601002463) |
Enumeration Date | 2007-11-06 |
Last Update Date | 2015-03-20 |