NPI | 1417126087 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 000653) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 000653) |
Enumeration Date | 2008-02-27 |
Last Update Date | 2012-06-15 |