NPI | 1518908524 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MT 273) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MT 273) |
Enumeration Date | 2006-06-09 |
Last Update Date | 2014-08-26 |