NPI | 1639128838 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AL PA-34) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA34) |
Enumeration Date | 2006-05-08 |
Last Update Date | 2008-06-30 |