NPI | 1992920110 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 5822) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN AT0671) |
Enumeration Date | 2007-04-14 |
Last Update Date | 2018-12-20 |