NPI | 1184623621 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CO 3005) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 1058385) |
Enumeration Date | 2005-07-18 |
Last Update Date | 2024-02-13 |