NPI | 1356614655 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C04705) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0004705) |
Enumeration Date | 2012-02-16 |
Last Update Date | 2014-10-07 |