NPI | 1518020056 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 3537) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 3537) |
Enumeration Date | 2006-12-18 |
Last Update Date | 2016-09-20 |