NPI | 1295734077 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 102235) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 102235) |
Enumeration Date | 2005-07-14 |
Last Update Date | 2020-12-17 |