NPI | 1952705246 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0005499) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003391) |
Enumeration Date | 2014-10-15 |
Last Update Date | 2015-04-06 |