NPI | 1194754820 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 2487) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 2487) |
Enumeration Date | 2006-07-03 |
Last Update Date | 2007-11-26 |