NPI | 1558664458 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-861) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: ID PA-861) |
Enumeration Date | 2010-12-15 |
Last Update Date | 2011-04-04 |