NPI | 1679662142 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: LA PA.200159) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX PA04446) |
363AS0400X Physician Assistant, Surgical (Licence: LA PA.200159) | |
Enumeration Date | 2006-10-12 |
Last Update Date | 2013-02-25 |