NPI | 1356358089 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA MA788) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA 788) |
Enumeration Date | 2006-08-02 |
Last Update Date | 2013-07-15 |