NPI | 1063666097 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA2564) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA 2564) |
Enumeration Date | 2008-11-04 |
Last Update Date | 2024-02-16 |