NPI | 1275776700 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 3390) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 20209) |
Enumeration Date | 2009-04-14 |
Last Update Date | 2015-02-25 |