NPI | 1003391434 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 7291) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 7291) |
Enumeration Date | 2018-10-02 |
Last Update Date | 2024-11-22 |