NPI | 1891062055 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA4590) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002600) |
Enumeration Date | 2011-11-16 |
Last Update Date | 2012-12-28 |