NPI | 1154307569 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: PA MA050819) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA002654) |
363AS0400X Physician Assistant Surgical (Licence: LA PA.200031) | |
Enumeration Date | 2005-12-16 |
Last Update Date | 2019-01-23 |