NPI | 1033430152 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA9105552) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2010-06-14 |
Last Update Date | 2021-08-10 |