NPI | 1770591760 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC 897) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 897) |
363AM0700X Physician Assistant, Medical (Licence: SC 897) | |
Enumeration Date | 2006-08-04 |
Last Update Date | 2021-01-27 |