NPI | 1316976814 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 1850-023) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA15815) |
363AS0400X Physician Assistant, Surgical (Licence: WI 1850-023) | |
Enumeration Date | 2006-06-30 |
Last Update Date | 2022-09-06 |