NPI | 1053128215 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 22-448) |
246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 24-448) | |
Enumeration Date | 2024-12-11 |
Last Update Date | 2025-04-01 |