NPI | 1043658347 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 51936) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NM PA2013-0033) |
Enumeration Date | 2013-06-08 |
Last Update Date | 2015-05-18 |