NPI | 1861546715 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: DE C5-0000450) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD c03475) |
Enumeration Date | 2007-01-22 |
Last Update Date | 2009-10-02 |