NPI | 1972550192 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9219) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 100369) |
363AM0700X Physician Assistant, Medical (Licence: AK PADA547) | |
Enumeration Date | 2006-05-31 |
Last Update Date | 2022-08-12 |