NPI | 1093107997 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA52384) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110-004862) |
363AM0700X Physician Assistant, Medical (Licence: VA 0110-004862) | |
Enumeration Date | 2015-03-02 |
Last Update Date | 2017-04-12 |