NPI | 1770928160 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3082-33) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WI 1105912) |
Enumeration Date | 2013-04-30 |
Last Update Date | 2013-04-30 |