NPI | 1124417852 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 003275) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 003275) |
363AS0400X Physician Assistant, Surgical (Licence: CT 003275) | |
Enumeration Date | 2015-01-19 |
Last Update Date | 2015-03-24 |