NPI | 1891864815 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MO 2017002705) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2006-11-06 |
Last Update Date | 2018-04-04 |