NPI | 1548250954 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: OH 50-00-2337) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WA PA60150118) |
Enumeration Date | 2005-10-26 |
Last Update Date | 2015-04-16 |