NPI | 1003878125 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 6059) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA168858) |
Enumeration Date | 2006-04-04 |
Last Update Date | 2015-06-22 |