NPI | 1093111304 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5941) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical |
Enumeration Date | 2014-11-13 |
Last Update Date | 2018-04-19 |