NPI | 1043243330 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 000705) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA052532) |
Enumeration Date | 2006-07-09 |
Last Update Date | 2012-07-09 |