NPI | 1013685007 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: HI AMD-1092) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2021-09-02 |
Last Update Date | 2021-12-08 |