NPI | 1235293804 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OK 5062) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AL PA-508) |
Enumeration Date | 2006-12-20 |
Last Update Date | 2023-08-21 |