NPI | 1255885471 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OK 2619) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2619) |
Enumeration Date | 2016-08-04 |
Last Update Date | 2021-01-01 |