NPI | 1336698307 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
Additional Taxonomies | 363A00000X Physician Assistant |
363AM0700X Physician Assistant, Medical | |
Enumeration Date | 2016-09-30 |
Last Update Date | 2018-11-06 |