NPI | 1881624914 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-01143) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA368) |
Enumeration Date | 2006-07-04 |
Last Update Date | 2008-06-25 |