NPI | 1023260833 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-01573) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-01573) |
Enumeration Date | 2008-10-13 |
Last Update Date | 2008-10-13 |