NPI | 1366406688 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 000303) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: CT 000303) |
Enumeration Date | 2006-04-13 |
Last Update Date | 2007-07-08 |