NPI | 1063829653 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
Additional Taxonomies | 171000000X Military Health Care Provider |
363A00000X Physician Assistant | |
Enumeration Date | 2014-07-16 |
Last Update Date | 2025-03-24 |