NPI | 1235340811 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 17546) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA17546) |
Enumeration Date | 2007-05-24 |
Last Update Date | 2012-11-20 |