NPI | 1225368483 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-03472) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110003211) |
363AS0400X Physician Assistant, Surgical (Licence: NC 0010-03472) | |
Enumeration Date | 2010-01-11 |
Last Update Date | 2022-09-01 |