NPI | 1881971836 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA161246) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2049) |
Enumeration Date | 2011-11-04 |
Last Update Date | 2013-05-30 |