NPI | 1154748879 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CT 23.003060) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 23.003060) |
Enumeration Date | 2014-03-19 |
Last Update Date | 2021-12-07 |