NPI | 1164568135 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 3198) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 003198) |
363AS0400X Physician Assistant, Surgical (Licence: AL PA.657) | |
Enumeration Date | 2007-01-29 |
Last Update Date | 2025-04-03 |