NPI | 1174506232 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 2188) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 2188) |
Enumeration Date | 2005-11-22 |
Last Update Date | 2019-03-20 |