NPI | 1891750097 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110004367) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN PA0000001123) |
Enumeration Date | 2006-04-19 |
Last Update Date | 2019-12-17 |