NPI | 1427415058 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110005190) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110005190) |
Enumeration Date | 2016-01-27 |
Last Update Date | 2016-08-17 |