NPI | 1487841169 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: PA 07-263 SA-C) |
Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other Surgical Technologist |
Enumeration Date | 2007-09-26 |
Last Update Date | 2007-10-18 |