NPI | 1952490013 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC 1325) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA 1582) |
Enumeration Date | 2006-10-12 |
Last Update Date | 2015-10-20 |