NPI | 1114992666 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 211) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 000211) |
Enumeration Date | 2006-02-20 |
Last Update Date | 2018-08-21 |