NPI | 1912972175 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AK 944) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR pa00769) |
Enumeration Date | 2006-02-21 |
Last Update Date | 2011-03-01 |