NPI | 1982857702 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-986) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 7164781-1206) |
Enumeration Date | 2008-10-23 |
Last Update Date | 2016-02-02 |