NPI | 1275784068 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 2360) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PAT9104791) |
363AS0400X Physician Assistant, Surgical (Licence: FL PAT9104791) | |
Enumeration Date | 2008-10-10 |
Last Update Date | 2009-12-29 |