NPI | 1689761736 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 2030) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WY 489) |
Enumeration Date | 2006-10-09 |
Last Update Date | 2013-01-10 |