NPI | 1194265371 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005673) |
Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: VA 0110005673) |
Enumeration Date | 2017-03-07 |
Last Update Date | 2023-09-18 |