NPI | 1205968484 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
363AM0700X Physician Assistant, Medical | |
Enumeration Date | 2007-03-12 |
Last Update Date | 2013-08-15 |