NPI | 1982942850 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C06362) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 006710) |
363AM0700X Physician Assistant, Medical (Licence: MD C0006362) | |
363AM0700X Physician Assistant, Medical (Licence: GA 006710) | |
Enumeration Date | 2013-01-28 |
Last Update Date | 2023-01-25 |