NPI | 1023643251 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9682) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2020-03-09 |
Last Update Date | 2023-05-26 |