NPI | 1437308202 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: LA PA.TPA.638) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA PA.TPA.638) |
363AM0700X Physician Assistant, Medical (Licence: LA PA.TPA.638) | |
Enumeration Date | 2008-09-16 |
Last Update Date | 2009-03-26 |