NPI | 1134957517 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012604) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601012604) |
Enumeration Date | 2024-07-25 |
Last Update Date | 2024-09-30 |