NPI | 1144773268 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MD4068967) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2016-07-25 |
Last Update Date | 2020-02-03 |