NPI | 1316210545 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: RI PA00628) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA PA4326) |
Enumeration Date | 2012-02-19 |
Last Update Date | 2012-02-19 |