NPI | 1639448780 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 2059) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OK 2059) |
363AM0700X Physician Assistant, Medical (Licence: OK 2059) | |
Enumeration Date | 2011-12-19 |
Last Update Date | 2019-04-23 |