NPI | 1932130374 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61005432) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 007601) |
Enumeration Date | 2006-07-05 |
Last Update Date | 2020-12-15 |