NPI | 1922052208 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 004114) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 004114) |
Enumeration Date | 2006-05-20 |
Last Update Date | 2008-11-12 |