NPI | 1588614390 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C0001456) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0001456) |
Enumeration Date | 2006-05-11 |
Last Update Date | 2008-09-23 |