NPI | 1245722909 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
Enumeration Date | 2018-05-30 |
Last Update Date | 2025-07-22 |