NPI | 1922164730 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA051284) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA051284) |
Enumeration Date | 2006-12-28 |
Last Update Date | 2022-07-21 |