NPI | 1073648465 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-00823) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2007-02-23 |
Last Update Date | 2022-01-14 |