NPI | 1144920612 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 62444) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 62444) |
Enumeration Date | 2023-03-03 |
Last Update Date | 2023-03-03 |