NPI | 1982937066 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ID 116257) |
Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: ID 116257) |
Enumeration Date | 2009-09-08 |
Last Update Date | 2015-06-18 |