NPI | 1215357108 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 11596) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WI 3312-23) |
Enumeration Date | 2014-04-18 |
Last Update Date | 2015-07-01 |