NPI | 1013576982 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 8061) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 13269) |
Enumeration Date | 2019-06-13 |
Last Update Date | 2025-06-16 |