NPI | 1093709016 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA002766L) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA002766L) |
363AS0400X Physician Assistant, Surgical (Licence: PA MA002766L) | |
Enumeration Date | 2005-09-06 |
Last Update Date | 2009-08-04 |