NPI | 1871633826 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 13178) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA 13178) |
Enumeration Date | 2007-02-07 |
Last Update Date | 2007-07-08 |