NPI | 1942240866 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 4388) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WY 362) |
Enumeration Date | 2006-06-08 |
Last Update Date | 2020-09-29 |