NPI | 1194159111 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 65664) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2013-08-27 |
Last Update Date | 2024-01-18 |