NPI | 1134591704 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 6192) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 6192) |
Enumeration Date | 2015-10-22 |
Last Update Date | 2024-10-31 |