NPI | 1982650966 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0003009) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MD C03009) |
Enumeration Date | 2006-05-25 |
Last Update Date | 2019-09-04 |