NPI | 1417905787 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 412-023) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 412-023) |
363AM0700X Physician Assistant, Medical (Licence: WI 412-023) | |
Enumeration Date | 2006-05-05 |
Last Update Date | 2010-05-12 |