NPI | 1003923293 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR pa00498) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA pa10003619) |
Enumeration Date | 2006-08-24 |
Last Update Date | 2007-07-08 |