NPI | 1225075328 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NH 0238P) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: ME PA 880) |
Enumeration Date | 2006-05-31 |
Last Update Date | 2023-10-04 |