NPI | 1689872830 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10000934A) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IN 10000934A) |
Enumeration Date | 2007-07-10 |
Last Update Date | 2011-01-26 |