NPI | 1982630851 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1345) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085000573) |
Enumeration Date | 2006-06-23 |
Last Update Date | 2013-02-26 |