NPI | 1154604452 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 0004374) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: ME PA001288) |
Enumeration Date | 2011-09-22 |
Last Update Date | 2015-10-05 |