NPI | 1932378213 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WV 1311) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 01311) |
Enumeration Date | 2008-02-21 |
Last Update Date | 2018-10-31 |