NPI | 1699731240 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA-4) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: AL PA-4) |
Enumeration Date | 2006-04-24 |
Last Update Date | 2010-02-26 |