NPI | 1013233261 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5777) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 5777) |
Enumeration Date | 2010-04-13 |
Last Update Date | 2022-07-29 |