NPI | 1104888015 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C-00072) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MD C0000072) |
Enumeration Date | 2006-04-05 |
Last Update Date | 2023-03-07 |