NPI | 1508018334 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA051964) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA051964) |
Enumeration Date | 2008-10-10 |
Last Update Date | 2015-08-03 |