NPI | 1942243092 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1445) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 005544) |
363A00000X Physician Assistant (Licence: UT 6961599-1206) | |
Enumeration Date | 2006-06-14 |
Last Update Date | 2014-03-25 |