NPI | 1093979155 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MT 218) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 002776) |
363AM0700X Physician Assistant Medical (Licence: GA 002776) | |
363AS0400X Physician Assistant Surgical (Licence: GA 002776) | |
Enumeration Date | 2008-07-17 |
Last Update Date | 2011-10-27 |