NPI | 1093136624 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 5559) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5559) |
363AS0400X Physician Assistant, Surgical (Licence: AZ 5559) | |
Enumeration Date | 2013-12-28 |
Last Update Date | 2024-05-15 |