NPI | 1992866784 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005545) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0002740) |
363AM0700X Physician Assistant, Medical (Licence: MI 5601005545) | |
Enumeration Date | 2006-12-13 |
Last Update Date | 2013-04-11 |