NPI | 1023033552 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA16667) |
Additional Taxonomies | 208600000X Surgery (Licence: CA PA16667) |
Enumeration Date | 2006-07-13 |
Last Update Date | 2010-07-26 |