NPI | 1336305796 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 53479) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 009782) |
174400000X Specialist (Licence: DC PA030526) | |
Enumeration Date | 2008-08-05 |
Last Update Date | 2016-11-30 |