NPI | 1093199796 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 3605-23) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 3605) |
Enumeration Date | 2015-07-13 |
Last Update Date | 2024-09-18 |