NPI | 1588918270 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: DC SA0078) |
Enumeration Date | 2012-11-01 |
Last Update Date | 2015-01-22 |