NPI | 1679556104 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 1315) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: OK 1315) |
Enumeration Date | 2005-11-29 |
Last Update Date | 2021-02-07 |