NPI | 1003332958 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: IN 10002383A) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10002383A) |
Enumeration Date | 2017-08-22 |
Last Update Date | 2020-12-16 |