NPI | 1902235443 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SD 0903) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1102022) |
Enumeration Date | 2013-11-05 |
Last Update Date | 2014-07-31 |