NPI | 1922401595 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3436) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WI 3436-23) |
Enumeration Date | 2014-09-26 |
Last Update Date | 2016-03-23 |