NPI | 1417096819 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 000058) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO 58) |
Enumeration Date | 2007-02-05 |
Last Update Date | 2016-05-02 |